Device for medical percussion

ABSTRACT

A mechanical tapper clips onto the end of a stethoscope. The device is operated by pressing a small plunger with the index finger of the hand holding the end of the stethoscope onto the patient&#39;s body to aid the percussion portion of a physical exam.

RELATED APPLICATION

This application is a continuation-in-part of U.S. application Ser. No.10/939,978 filed Sep. 13, 2004, now abandoned, which is a continuationof U.S. application Ser. No. 10/235,680, filed Sep. 5, 2002, now U.S.Pat. No. 6,790,184. The entire teachings of the above applications areincorporated herein by reference.

BACKGROUND OF THE INVENTION

The percussion examination is an integral portion of every generalphysical exam of the thorax and many specialty exams including thepulmonary exam and the abdominal exam. The percussion exam is used toidentify a variety of normal anatomical landmarks and to identifypathological conditions such as ascites, pulmonary infiltrates, andorganomegally. The standard percussion exam is performed by placing onehand with spread fingers on the patient. One finger of the other hand isused to strike one finger of the hand on the patient in a brisk swingingmotion. The resulting tapping action results in an audible sound whichmay be characterized as “tympanic”, “resonant”, “dull”, or a variety ofother variations. These sounds are then used to identify the boundariesof organs or the presence of abnormalities.

The sound heard from the standard method of percussion is often veryfaint and therefore very difficult to interpret. In addition to beingdifficult to hear, the quality may be affected by the characteristics ofthe examiner's fingers themselves and the examiner's personal examtechnique. The standard exam consists of multiple taps on the patientused for point to point comparison of the changes in sound at differentplaces on the patient. Therefore, variations in the technique from onetap to another or one physician to another may affect the results of theexam.

SUMMARY OF THE INVENTION

A medical percussion device aids during the percussion portion of aphysical exam of the thorax or abdomen. The device includes a baseextending from a head of a stethoscope with a hammer support extendingtherefrom. The device also includes a hammer supported by the hammersupport and actuated to tap on a patient while the stethoscope head isadjacent to the skin of the patient. In one embodiment, the device isessentially a small mechanical “tapper” which is operated by pressing asmall plunger with the index finger of the hand holding the end of thestethoscope onto the patient's body. During a normal percussion exam,the physician taps on the abdomen or thorax with a finger from one handhitting a finger of the other hand placed on the body. The very faintsounds heard from this action can be classified as “tympanic, dull,resonant, etc” and help to diagnose organomegaly, ascities, lunginfiltrates and other anatomy and abnormalities. This device aids in theexam by amplifying the percussion sounds heard because it is usedtogether with the stethoscope. It also allows for one hand operation sothis exam can be easily combined with the auscultation portion of theregular physical exam.

In some embodiments, the device includes a base adapted to be clipped tothe head of the stethoscope with a hammer support extending over apatient, and a hammer supported by the hammer support and actuated by auser to tap on the patient. In other embodiments, the base is integratedwith the head of the stethoscope. The hammer may include a finger padthat is depressed by the user to actuate the hammer, and a flared pistonhead piece that taps on the patient when the user depresses the fingerpad. The finger pad and the head piece can be made from stainless steelor other engineering materials. In certain embodiments, the hammerincludes a main piston body positioned within a casing that is supportedby the hammer support. The casing may be made from stainless steel,while the piston body may be made from brass. The base may be made fromplastic

Some embodiments can have a spring positioned around at least a portionof the main piston body and within the casing. In such embodiments, thespring acts to return the hammer to its starting position after beingactuated by the user. The spring can be a stainless steel compressionspring. The base can be secured to the head of the stethoscope with aset-screw. In other embodiments, the hammer is activated by anelectronic actuator.

Some embodiments may have one or more of the following advantages. Thedevice greatly improves acoustics due to its design and use inconjunction with the stethoscope. In addition, the device allows for aone-hand percussion examination which will allow the healthcareprofessional to use the other hand for other purposes and to accessportions of the body which may be more difficult to reach with twohands. This device conveniently attaches to the stethoscope andtherefore is easy to carry and use. The spring-loaded piston provides aregular tapping action and may allow for a more astute diagnose ofdifferences in the acoustic response from one point to another on thepatient.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, features and advantages of theinvention will be apparent from the following more particulardescription of preferred embodiments of the invention, as illustrated inthe accompanying drawings in which like reference characters refer tothe same parts throughout the different views. The drawings are notnecessarily to scale, emphasis instead being placed upon illustratingthe principles of the invention.

FIG. 1 is a perspective view of a stethoscope head with a medicalpercussion device in accordance with the invention;

FIG. 1A is a perspective view of the medical percussion device of FIG.1;

FIG. 2 is a top view of the medical percussion device of FIGS. 1 and 1A;

FIG. 2A is a cross-sectional view of the medical percussion device alongthe line 2A-2A of FIG. 2;

FIG. 2B is a bottom view of the medical percussion device of FIGS. 1 and1A;

FIG. 2C is an end view of the medical percussion device along the line2C-2C of FIG. 2;

FIG. 2D is an end view of the medical percussion device along the line2D-2D of FIG. 2;

FIG. 2E is a close-up view of the medical percussion device in theregion 2E of FIG. 2A;

FIG. 3 is a cross-sectional view of an alternative embodiment of themedical percussion device;

FIGS. 4A and 4B illustrate a sequence of steps for using the medicalpercussion device in accordance with the invention;

FIG. 5 is a perspective view of an alternate embodiment of a stethoscopewith a medical percussion device; and

FIG. 6 is a perspective view of an alternate embodiment of the inventionin which the hammer-action assembly is driven by an electronic actuatorrather than a spring-piston mechanism.

DETAILED DESCRIPTION OF THE INVENTION

A description of preferred embodiments of the invention follows.

Referring to FIGS. 1, 1A, 2 and 2B-2D, there is shown a medicalpercussion device 10, which is a ring-shaped device approximately 2inches in diameter constructed from either metal or plastic. It has twoaspects to its design: a base portion 12 and a hammer-action assembly14.

The base portion 12 is designed to attach to a stethoscope 16 (FIG. 1)and is shaped like an open-ended ring so that it can slip around thehead of the stethoscope. The base 12 includes a screw clamp, such as aset-screw 18, to help hold the percussion device 10 securely in place onthe stethoscope head 16.

In one embodiment, the base portion 12 is made from surgical gradestainless steel and is machined from one solid piece of metal. Inalternate embodiments, the base portion can be fabricated from plasticor other engineering materials. The base portion 12 has two smallerholes (one is threaded) on the two “tails” so that the stainless steelthumb screw 18 can be fed through this part in order to secure the base12 to the stethoscope-head 16. The other side of the base piece 12 has awide threaded hole to accommodate the hammer-action assembly 14described below. The hammer-action assembly 14 screws into the base 12at this larger hole.

Referring now to FIGS. 2A and 2E, the hammer-action assembly 14 includesa piston assembly 19 having a metal piston 20 with detachable (screw in)flared head 22 and a detachable (screw in) finger pad 24, a spring 26,and a casing tube made from two parts 28 and 30. The flared head 22 ofthe piston comes into contact with the patient's skin as the piston ispressed by an examining medical professional. The finger pad 24 is theportion of the hammer-action assembly 14 that is depressed by thephysician during the percussion exam. The spring 26 acts to return thedepressed piston 20 to its starting position. The casing tube 28 and 30covers the three pieces of the piston 20, 22, and 24 and holds thespring 26 in place. The casing tube 28 and 30 is made from two pieces ofstainless steel rod which are both first drilled through to accommodatethe piston 20. Then, a recess is created in each rod by milling down thecenter of each rod and leaving a lip on the end of each piece so thatonce attached together, the spring 26 and piston 20 will be securedinside the casing 28 and 30 via this ledge. To attach the two pieces ofthe casing 28 and 30 to one another, one piece is turned down a smallamount and threaded while the other piece is bored out a small amountand tapped. These two rods join at this threaded joint. In addition, theouter edge of the casing 30 is threaded to mate with the tapper base 12.

As mentioned above, the piston assembly 19 is made from three pieces 20,22, and 24. The finger pad piece 24 is made of stainless steel byturning down a stainless steel rod on the lathe to create a flat surfacefor the finger to press followed by a shaft. The last few millimeters ofthe shaft are further turned down and then threaded to create the jointbetween the finger pad piece 24 and the main piston body 20.

The main piston body 20 is made from brass. Brass is used because it hasself-lubricating properties while still maintaining an appreciabledensity (as opposed to Teflon). The main piston body 20 is made by firstdrilling and tapping either end of a brass rod in order to create amating threaded hole for the finger pad 24 and piston head 22. Theneither end of the brass rod is turned down on the lathe to a diameterwhich will fit through the holes created in the casing tube.

The piston head piece 22 is made from stainless steel rod which isturned down on a lathe. The head itself is made round and smooth becauseit will come into contact with the patient. The shaft is further turneddown and threaded at the last few millimeters in order to mate the shaftof the piston head 22 to the threaded hole in the piston body piece 20described above. The spring 26 is a stainless steel compression springwithout modification.

The hammer-action assembly 14 is formed by aligning the piston body 20into the top half 28 of the casing piece. Then the spring 26 is slidover the bottom portion of the piston body 20 and is compressed as thebottom half 30 of the casing is mated to the top half 28 and securelyscrewed together. Next, the finger pad 24 and piston head 22 are matedto the threaded holes of the piston body 20 which are protruding out ofthe casing pieces.

The hammer-action assembly 14 can then be screwed into place on thetapper base piece 12 by mating the threaded portion of the bottom halfof the casing 30 to the threaded hole of the base piece 12. Finally, thestainless steel set-screw 18 can be pressed into the holes in the tailsof the base piece 12.

Referring now to FIG. 3, there is shown an alternative embodiment of thepercussion device 10 with pieces made from a die-casting or from aplastic injection molding process, so that the part count may be reducedfrom eight to four total pieces. In this embodiment, the base piece 12,upper casing 28, and lower casing 30 may all be combined into twosymmetrically split pieces, of which one is shown in FIG. 3, which meetand are assembled around the piston 19. The piston 19 may be formed froma single piece (reducing it from 3 pieces to 1 piece). In this design,the spring 26 is first positioned on the piston 19. Then the piston 19and spring 26 are placed in one half of the combined base-casing part.Finally, the other symmetrical base-casing part is mated to theidentical half and the two are sealed together with a bonding material.The stainless steel set-screw 18 is pushed into the holes at the tailsof the base 12 as described above. If the base-casing combined part ismade from plastic, the set-screw may not be necessary as the plastic maybe flexible enough to allow for a tight fit without a set-screw.

In use, as illustrated in FIGS. 4A and 4B, the mechanical percussiondevice 10 attaches to the head of the stethoscope 16 and is designed tobe used in conjunction with the stethoscope. While the healthcareprofessional is listening to the thorax or abdomen with the stethoscope,the percussion device 10 may be used by depressing the spring-loadedpiston 19 with the index finger, F (FIG. 4B), of the same hand thatholds the stethoscope head 16 against the patient's skin, S. Theresonant sounds of the body cavity will be distinctly audible throughthe stethoscope earpieces. The topologic pattern of percussion andcomparative percussion techniques described in clinical medicine textssuch as “Bates' Guide to Physical Examination and History Taking, 8thedition,” by Lynn S. Bickley and Peter G. Szilagyi, Lippincott Williams& Wilkins, Philadelphia, 2003, the entire contents of which areincorporated herein by reference, may still be followed with thepercussion device 10. The piston may be repeatedly depressed andreleased to created a consistent and regular tapping action that willaid in diagnoses.

FIG. 5 is a perspective view of an alternate embodiment of a stethoscopewith a medical percussion device. In this embodiment, the mechanicalpercussion device is integrated into the design of the head of astethoscope itself. FIG. 6 is a perspective view of an alternateembodiment of the invention in which a hammer-action assembly 40 isdriven by an electronic actuator 42 rather than a spring-pistonmechanism. In this embodiment, a small electro-magnetic actuator 42replaces the spring-piston mechanism in order to drive the hammer. Theelectronic actuator 42 includes an on/off button 44. The electronicactuator 42 is powered by a battery that is located inside the actuator.

The hammer-action assembly 40 also includes a detachable (screw in)flared head 22. The flared head 22 of the piston comes into contact withthe patient's skin as the hammer-action assembly 40 is driven by theelectronic actuator 42. In the electronic actuator embodiment, thetapping action is exactly reproducible from point to point on thepatient because the actuator mechanism ensures a repeatable forcedelivered to the hammer.

In general, the actuator 42 is a DC powered electronic device whichmakes small, repetitive linear motions. Most simply, the actuator can bea pulse-duty push-type solenoid which can create a short, forceful pushon the hammer assembly and therefore create the “tapping action” of thepercussion device. For example, the actuator can include a standardsolenoid, for example, a solenoid manufactured by KGS America LLC.

In an alternate embodiment, the electronic actuator can be a simple DCmotor with a cam and follower mechanism which couples the rotary axis ofthe DC motor to the spring/hammer assembly to create a repetitive linear“tapping action” of the hammer. A cam and follower is a standardengineering mechanism well-known to those skilled in the art.

While this invention has been particularly shown and described withreferences to preferred embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the scope of the inventionencompassed by the appended claims. For instance, the shape and feel ofthe device can be different than that described above. Any suitablematerial can be used to make the various parts of the percussion device.The hammer action can implement different types of mechanicalmechanisms, such as, tube bearing, weighted pivot, rolling weight, andbow action snap-back mechanisms. Other types of designs for differentfinger motions for the mechanical action are contemplated, as well, suchas, for example, angled piston motion, rolling motion, or a cameratrigger motion with a button on the edge of the device rather than onthe back of the device. Moreover, an electronic or electromagneticactuator can be used in place of the manual device.

1. A medical percussion device comprising: a base extending from a headof a stethoscope with a hammer support extending therefrom laterallyproximate the head of the stethoscope; and a hammer supported by thehammer support and actuated to tap on a patient while the stethoscopehead is adjacent to the skin of the patient.
 2. The device of claim 1,wherein the hammer includes a finger pad that is depressed by a user toactuate the hammer.
 3. The device of claim 2, wherein the hammerincludes a flared piston head piece that taps on the patient when theuser depresses the finger pad.
 4. The device of claim 1, furthercomprising a casing supported by the hammer support, the hammer having amain piston body being positioned in the casing.
 5. The device of claim4, further comprising a spring positioned around at least a portion ofthe main piston body and within the casing, the spring acting to returnthe hammer to the hammer's starting position after being actuated by theuser.
 6. The device of claim 1, wherein the hammer is actuated by anelectronic actuator.
 7. The device of claim 1, wherein the base isintegrated with the head of the stethoscope.
 8. The device of claim 1,wherein the base is adapted to be clipped to the head of thestethoscope.
 9. The device of claim 1, wherein the base is made fromplastic.
 10. A medical percussion device comprising: means for extendinga base with a hammer support from a head of a stethoscope, the hammersupport extending laterally proximate the head of the stethoscope; andmeans for actuating a hammer supported by the hammer support to tap onthe patient while the stethoscope head is adjacent to the skin of thepatient.
 11. A method of aiding the percussion portion of a physicalexam of a patient comprising: extending a base with a hammer supportfrom a head of a stethoscope while extending the hammer supporttherefrom laterally proximate the head of the stethoscope; and actuatinga hammer supported by the hammer support to tap on the patient while thestethoscope head is adjacent to the skin of the patient.
 12. The methodof claim 11, wherein the actuating includes depressing a finger pad ofthe hammer.
 13. The method of claim 12, wherein the depressing causes ahead piece of the hammer to tap on the patient.
 14. The method of claim11, further comprising returning the hammer to the hammer's startingposition after the actuating.
 15. The method of claim 11, wherein thehammer is actuated by an electronic actuator.
 16. The method of claim11, wherein the hammer is actuated by a mechanical coupling.
 17. Astethoscope comprising: a stethoscope head; a base extending from thestethoscope head with a hammer support extending therefrom laterallyproximate the head of the stethoscope; and a hammer supported by thehammer support and actuated to tap on a patient while the stethoscopehead is adjacent to the skin of the patient.
 18. The stethoscope ofclaim 17, wherein the base is integrated with the stethoscope head. 19.The stethoscope of claim 17, wherein the base is adapted to be clippedto the stethoscope head.
 20. The stethoscope of claim 17, wherein thebase is made from plastic.